The burden of mental disorder in Sierra Leone: a retrospective observational evaluation of programmatic data from the roll out of decentralised nurse-led mental health units
Abstract Background In sub-Saharan Africa the treatment gap for mental disorders is high. In 2009, 98.0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response, the Ministry of Health and...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-04-01
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| Series: | International Journal of Mental Health Systems |
| Online Access: | https://doi.org/10.1186/s13033-021-00455-1 |
| _version_ | 1818966130095554560 |
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| author | Helen Hopwood Stephen Sevalie Moshi Optat Herman Dawn Harris Katharine Collet Abdulai Jawo Bah Fenella Beynon |
| author_facet | Helen Hopwood Stephen Sevalie Moshi Optat Herman Dawn Harris Katharine Collet Abdulai Jawo Bah Fenella Beynon |
| author_sort | Helen Hopwood |
| collection | DOAJ |
| description | Abstract Background In sub-Saharan Africa the treatment gap for mental disorders is high. In 2009, 98.0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response, the Ministry of Health and Sanitation rolled out nurse-led mental health units (MHU) to every district. This study aims to retrospectively evaluate the uptake of these services by examining the pathways to care, diagnosis, management, and treatment gap, to provide insight into the functioning of these units and the potential burden of mental health disorders in Sierra Leone. Methods We evaluated the roll out of MHU using summary data from all units between 1 st January 2015 and 1 st January 2017, to establish the burden of diagnoses among service users, pathways to care, treatments provided, and treatment gaps. Negative binomial regressions examine bivariate relationships between diagnoses, treatments, and medication inaccessibility with demographics (age and sex), location (Freetown vs the rest and Ebola endemic regions vs the rest) and year. Results We collected data from 15 MHU covering 13 districts in 24 months. There were 2401 referrals. The largest age category was 25–34 (23.4%). The prominent diagnoses were epilepsy (43.5%, associated with children) and psychosis (17.5%, associated with males). Reported depression (8.6%) and suicide attempts (33 patients) were low. Ebola endemic regions reported higher rates of grief, trauma, and medically unexplained symptoms. In 24.7% of cases where medication was required, it was not accessible. Conclusions Nurse-led MHU can have a modest effect on the treatment gap in resource constrained environments such as Sierra Leone, particularly in epilepsy and psychosis. |
| first_indexed | 2024-12-20T13:28:00Z |
| format | Article |
| id | doaj.art-2efc0f787dc940efb7288e75ac54044d |
| institution | Directory Open Access Journal |
| issn | 1752-4458 |
| language | English |
| last_indexed | 2024-12-20T13:28:00Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Mental Health Systems |
| spelling | doaj.art-2efc0f787dc940efb7288e75ac54044d2022-12-21T19:39:11ZengBMCInternational Journal of Mental Health Systems1752-44582021-04-0115112710.1186/s13033-021-00455-1The burden of mental disorder in Sierra Leone: a retrospective observational evaluation of programmatic data from the roll out of decentralised nurse-led mental health unitsHelen Hopwood0Stephen Sevalie1Moshi Optat Herman2Dawn Harris3Katharine Collet4Abdulai Jawo Bah5Fenella Beynon6King’s Sierra Leone Partnership, King’s Global Health Partnerships, King’s Centre for Global Health and Health Partnerships, School of Population and Environmental Sciences, King’s College London34 Regimental Military HospitalKings College London Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College LondonKing’s Sierra Leone Partnership, King’s Global Health Partnerships, King’s Centre for Global Health and Health Partnerships, School of Population and Environmental Sciences, King’s College LondonSchool of Public Health, Imperial College LondonSustainable Health SystemsKing’s Sierra Leone Partnership, King’s Global Health Partnerships, King’s Centre for Global Health and Health Partnerships, School of Population and Environmental Sciences, King’s College LondonAbstract Background In sub-Saharan Africa the treatment gap for mental disorders is high. In 2009, 98.0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response, the Ministry of Health and Sanitation rolled out nurse-led mental health units (MHU) to every district. This study aims to retrospectively evaluate the uptake of these services by examining the pathways to care, diagnosis, management, and treatment gap, to provide insight into the functioning of these units and the potential burden of mental health disorders in Sierra Leone. Methods We evaluated the roll out of MHU using summary data from all units between 1 st January 2015 and 1 st January 2017, to establish the burden of diagnoses among service users, pathways to care, treatments provided, and treatment gaps. Negative binomial regressions examine bivariate relationships between diagnoses, treatments, and medication inaccessibility with demographics (age and sex), location (Freetown vs the rest and Ebola endemic regions vs the rest) and year. Results We collected data from 15 MHU covering 13 districts in 24 months. There were 2401 referrals. The largest age category was 25–34 (23.4%). The prominent diagnoses were epilepsy (43.5%, associated with children) and psychosis (17.5%, associated with males). Reported depression (8.6%) and suicide attempts (33 patients) were low. Ebola endemic regions reported higher rates of grief, trauma, and medically unexplained symptoms. In 24.7% of cases where medication was required, it was not accessible. Conclusions Nurse-led MHU can have a modest effect on the treatment gap in resource constrained environments such as Sierra Leone, particularly in epilepsy and psychosis.https://doi.org/10.1186/s13033-021-00455-1 |
| spellingShingle | Helen Hopwood Stephen Sevalie Moshi Optat Herman Dawn Harris Katharine Collet Abdulai Jawo Bah Fenella Beynon The burden of mental disorder in Sierra Leone: a retrospective observational evaluation of programmatic data from the roll out of decentralised nurse-led mental health units International Journal of Mental Health Systems |
| title | The burden of mental disorder in Sierra Leone: a retrospective observational evaluation of programmatic data from the roll out of decentralised nurse-led mental health units |
| title_full | The burden of mental disorder in Sierra Leone: a retrospective observational evaluation of programmatic data from the roll out of decentralised nurse-led mental health units |
| title_fullStr | The burden of mental disorder in Sierra Leone: a retrospective observational evaluation of programmatic data from the roll out of decentralised nurse-led mental health units |
| title_full_unstemmed | The burden of mental disorder in Sierra Leone: a retrospective observational evaluation of programmatic data from the roll out of decentralised nurse-led mental health units |
| title_short | The burden of mental disorder in Sierra Leone: a retrospective observational evaluation of programmatic data from the roll out of decentralised nurse-led mental health units |
| title_sort | burden of mental disorder in sierra leone a retrospective observational evaluation of programmatic data from the roll out of decentralised nurse led mental health units |
| url | https://doi.org/10.1186/s13033-021-00455-1 |
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